Provider Demographics
NPI:1336432194
Name:KAUR, SIMRAN (NP-C)
Entity Type:Individual
Prefix:
First Name:SIMRAN
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SIMRAN
Other - Middle Name:
Other - Last Name:SETHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2700 N 140TH AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2439
Mailing Address - Country:US
Mailing Address - Phone:623-535-8770
Mailing Address - Fax:623-414-3720
Practice Address - Street 1:2700 N 140TH AVE
Practice Address - Street 2:STE 107
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2439
Practice Address - Country:US
Practice Address - Phone:623-535-8770
Practice Address - Fax:623-414-3720
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ875014Medicaid
AZZ181439Medicare UPIN